Timor-Leste Achieves Malaria-Free Status, Highlighting Effective Health Strategies

The World Health Organization (WHO) has certified Timor-Leste as malaria-free, a remarkable achievement for a country that prioritized the disease and embarked on a concerted, nation-wide response shortly after gaining independence in 2002.“WHO congratulates the people and government of Timor-Leste on this significant milestone,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Timor-Leste’s success proves that malaria can be stopped in its tracks when strong political will, smart interventions, sustained domestic and external investment and dedicated health workers unite.”With today’s announcement, a total of 47 countries and 1 territory have been certified as malaria-free by WHO. Timor-Leste is the third country to be certified in the WHO South-East Asia region, joining Maldives and Sri Lanka which were certified in 2015 and 2016 respectively.Certification of malaria elimination is granted by WHO when a country has proven, beyond reasonable doubt, that the chain of indigenous transmission has been interrupted nationwide for at least the previous three consecutive years.“We did it. Malaria has been one of our most relentless enemies – silent, persistent, and deadly. We lost too many lives to a disease that should be preventable. But our health workers never gave up, our communities held strong, and our partners, like WHO, walked beside us. From 223 000 cases to zero – this elimination honours every life lost and every life now saved. We must safeguard this victory with continued vigilance and community action to prevent malaria's re-entry,” said Dr Élia António de Araújo dos Reis Amaral, SH, Minister of Health, Government of Timor-Leste. A rapid shift from high burden country to malaria-freeSince gaining independence in 2002, Timor-Leste has made remarkable strides in the fight against malaria – reducing cases from a peak of more than 223 000 clinically diagnosed cases in 2006 to zero indigenous cases from 2021 onwards.Timor-Leste’s success in eliminating malaria was driven by the Ministry of Health’s swift action in 2003 to establish the National Malaria Programme, a dedicated programme for planning, implementing, and monitoring malaria control efforts nationwide. With only two full-time officers initially, the programme was able to lay the foundation for progress early on through strong technical leadership, managerial capacity and attention to detail.Within a few years, the country introduced rapid diagnostic tests and artemisinin-based combination therapy as part of the National Malaria Treatment Guidelines and began distributing free long-lasting insecticide treated nets to communities most at risk.In 2009, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Timor-Leste scaled up nationwide vector control efforts through the distribution of long-lasting insecticide-treated nets and indoor residual spraying. Malaria diagnosis was also expanded using microscopy and rapid diagnostic tests at the point of care across all local health posts.Facing the challenges of severe shortages of health workers and doctors, Timor-Leste made investments and developed its three-tier health system – comprising national hospitals, reference hospitals, community health centers (CHCs), and health posts – to ensure most residents can access care within an hour's walk. Additionally, citizens are provided with free health services at the point of care, as part of the government’s policy on free universal health care. Monthly mobile clinics and community outreach programmes further enhance health services in rural areas.Timor-Leste’s success in combating malaria highlights the importance of country leadership and strong collaboration between the Ministry of Health, WHO, local communities, non-governmental organizations, donors, and multiple government sectors. A real-time integrated case-based surveillance system ensures rapid data collection and response, while trained health workers ensure timely detection and screening of malaria cases, including at borders. These integrated efforts have paved the way for the country to be officially certified malaria-free."Timor-Leste’s malaria-free certification is a defining national triumph – driven by bold leadership, tireless efforts of health workers, and the resolve of its people. As a young nation, Timor-Leste stayed focused – testing, treating, and investigating swiftly. Ending transmission and maintaining zero deaths takes more than science; it takes grit. This victory protects generations, present and future, and shows what a determined country can achieve,” said Dr Arvind Mathur, WHO Representative to Timor-Leste. Note to the editorWHO malaria-free certificationThe final decision on awarding a malaria-free certification is made by the WHO Director-General, based on a recommendation by the Technical Advisory Group on Malaria Elimination and Certification and validation from the Malaria Policy Advisory Group. More on WHO’s malaria-free certification process.